Highly lordosed fusion cage

ABSTRACT

A fusion cage has a first component that defines an outside surface that is configured to engage a vertebral endplate, and an interior surface. The fusion cage has a second component that defines first and second opposed surfaces. One of the first and second opposed surfaces can mate with the interior surface of the first component. The fusion cage can include vertical and lateral throughholes adapted to enhance fusion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 15/092,675 filed Apr. 7, 2016, which is a divisional of U.S. patent application Ser. No. 14,514,700 filed Oct. 15, 2014, which in turn is a divisional of U.S. patent application Ser. No. 11/768,636 filed Jun. 26, 2007, now issued as U.S. Pat. No. 8,900,307, the specification of each of which is incorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

The natural intervertebral disc contains a jelly-like nucleus pulposus surrounded by a fibrous annulus fibrosus. Under an axial load, the nucleus pulposus compresses and radially transfers that load to the annulus fibrosus. The laminated nature of the annulus fibrosus provides it with a high tensile strength and so allows it to expand radially in response to this transferred load.

In a healthy intervertebral disc, cells within the nucleus pulposus produce an extracellular matrix (ECM) containing a high percentage of proteoglycans. These proteoglycans contain sulfated functional groups that retain water, thereby providing the nucleus pulposus within its cushioning qualities. These nucleus pulposus cells may also secrete small amounts of cytokines such as interleukin-1β and TNF-α as well as matrix metalloproteinases (“MMPs”). These cytokines and MMPs help regulate the metabolism of the nucleus pulposus cells.

In some instances of disc degeneration disease (DDD), gradual degeneration of the intervetebral disc is caused by mechanical instabilities in other portions of the spine. In these instances, increased loads and pressures on the nucleus pulposus cause the cells within the disc (or invading macrophases) to emit larger than normal amounts of the above-mentioned cytokines In other instances of DDD, genetic factors or apoptosis can also cause the cells within the nucleus pulposus to emit toxic amounts of these cytokines and MMPs. In some instances, the pumping action of the disc may malfunction (due to, for example, a decrease in the proteoglycan concentration within the nucleus pulposus), thereby retarding the flow of nutrients into the disc as well as the flow of waste products out of the disc. This reduced capacity to eliminate waste may result in the accumulation of high levels of toxins that may cause nerve irritation and pain.

As DDD progresses, toxic levels of the cytokines and MMPs present in the nucleus pulposus begin to degrade the extracellular matrix, in particular, the MMPs (as mediated by the cytokines) begin cleaving the water-retaining portions of the proteoglycans, thereby reducing its water-retaining capabilities. This degradation leads to a less flexible nucleus pulposus, and so changes the loading pattern within the disc, thereby possibly causing delamination of the annulus fibrosus. These changes cause more mechanical instability, thereby causing the cells to emit even more cytokines, thereby upregulating MMPs. As this destructive cascade continues and DDD further progresses, the disc begins to bulge (“a herniated disc”), and then ultimately ruptures, causing the nucleus pulposus to contact the spinal cord and produce pain.

One proposed method of managing these problems is to remove the problematic disc and replace it with a porous device that restores disc height and allows for bone growth therethrough for the fusion of the adjacent vertebrae. These devices are commonly called “fusion devices”.

U.S. Pat. No. 5,865,848 (“Baker”) discloses a two piece intervertebral fusion cage having a ramp. Baker describes a intervertebral spacer comprised of two components. The two portions have opposed flanges connected by a screw to effect translation, and complimentary slopes. The components are inserted together in a collapsed condition. Post-insertion translation of one component relative to the other creates an expanded condition and the desired distraction. US Published Patent Application 2004/0230309 (“DePuy Spine”) discloses a two piece intervertebral fusion cage having a ramp. See FIG. 14D.

US Published Patent Application Nos. US2003/0135275 and 2003/0139812 (collectively, “Garcia”) disclose a two-piece implant formed by upper and lower halves, wherein the inner surfaces of the two halves form a dovetail joint that runs along a transverse axis of the implant.

SUMMARY OF THE INVENTION

The present invention is directed to a two-piece intervertebral fusion cage, comprising:

-   -   a) an upper component having a first outside surface adapted for         gripping an upper vertebral endplate and a first interior         surface,     -   b) a lower component having a second outside surface adapted for         gripping a lower vertebral endplate and a second interior         surface, wherein the interior surfaces mate.

One advantage of such a cage is its easy insertion. In a first step, the lower component is inserted into the disc space and is held in place. The first step confirms placement of the implant and its footprint. In a second step, the upper component is inserted into the disc space by sliding its interior surface along the opposed interior surface of the lower component. This two-step method of insertion eliminates the need to provide an independent distraction means, such as the use of an impaction hammer, and an independent trialing means. It also provides mechanical leverage in the cage to facilitate the creation of lordosis.

A second advantage of such a cage is its impact on patient safety. The gradual nature of the distraction of the disc space provided by this two-step insertion procedure should also reduce the possibility of over-distraction, which can cause neural damage. It also eliminates hammer-induced sudden impaction during cage insertion, thereby reducing cage failures, over-insertion and anterior damage. Lastly, the smaller height of the annular defect produced during device insertion aids in preventing device expulsion.

In a first aspect of the present invention, the outside surface of at least one of the components is substantially parallel to its corresponding interior surface. This provides the advantage of ease of insertion through a small annular defect/incision. Simply, one component can determine height and the other component can determine lordosis.

In a second aspect of the present invention, each component has a throughhole extending from its outside surface to its interior surface, and the interior surfaces of these components mate to align the first and second throughholes. This alignment provides a path for bone growth through the vertical dimension of the device, thereby facilitating fusion between the vertebral endplates.

In a third aspect of the present invention, each component has opposed sidewalls and at least one of the components has a lateral throughhole extending from a sidewall thereof to its opposed sidewall. This lateral throughhole provides a path for increased vascularization, increased diffusion, and bone growth through the lateral dimension of the device, thereby facilitating fusion between the vertebral endplates.

In a fourth aspect of the present invention, each component has a dovetail feature extending along the longitudinal axis of its interior surface and the dovetail features of the corresponding components mate along the longitudinal axes. This mating of dovetails provides for a locking of the mated upper and lower components and increases the assurance that the mated components will not disengage in vivo.

In a fifth aspect of the present invention, the upper component has a tapered distal end, preferably a bulleted nose. This tapered distal end allows for easy distraction of the opposed vertebral endplates upon insertion of the upper component into the disc space.

DESCRIPTION OF THE FIGURES

FIGS. 1 a, 1 b, 1 c, and 1 d disclose a cage of the present invention having mating dovetail features and aligned vertical throughholes.

FIGS. 1 e, 1 f, and 1 g disclose the sequential insertion and assembly of the components of the device into the disc space.

FIG. 2 discloses a cage of the present invention having a lateral throughhole extending from a sidewall thereof to its opposed sidewall, and an outside surfaces that is substantially parallel to its corresponding interior surface.

FIG. 3 discloses an exploded cage of the present invention having a bulleted distal nose, along with an assembled cage attached to an insertion instrument.

FIG. 4 discloses an interior surface of the lower component that is angled with respect to its corresponding outer surface, thus creating lordosis.

FIG. 5 a discloses a cage of the present invention wherein an inside surface of the first component has a recess, and an inside surface of the second component has an extension, wherein the recess and extension mate to provide nesting of the components.

FIGS. 5 b and 5 c disclose a method of inserting the device of FIG. 5 a.

FIG. 6 discloses a cage of the present invention wherein one of the components has extending side walls that create a housing adapted to capture the other component.

FIGS. 7 a and 7 b disclose the device of the present invention attached to an insertion instrument.

FIGS. 8 a . 8 b, and 8 c disclose arcuate cages of the present invention.

FIG. 8 d discloses an arcuate cage inserted into a disc space.

DETAILED DESCRIPTION OF THE FIGURES

For the purposes of the present invention, the terms “inner surface”, “inside surface” “interior surface are interchangeable, as are the terms “exterior surface”, “outer surface” and “outside surface”.

In general, the cage possesses a two-piece structure with hard-endplates and a locking means that is compatible with MIS techniques. Both the top and bottom portions have an interior and exterior surface (FIG. 1 ), where the exterior surface interfaces with the vertebra.

Now referring to FIGS. 1 a-1 d , there is provided an intervertebral fusion cage, comprising:

-   -   a) an upper component 1 having a first outside surface 3 adapted         for gripping an upper vertebral endplate, a first interior         surface 5 having a first longitudinal axis, a first throughhole         7 extending from the outside surface to the first interior         surface, and a first dovetail feature (not shown) extending         along the first longitudinal axis, and     -   b) a lower component 11 having a second outside surface 13         adapted for gripping a lower vertebral endplate, a second         interior surface 15 having a second longitudinal axis, a second         throughhole 17 extending from the outside surface to the second         interior surface, and a second dovetail feature 19 extending         along the first longitudinal axis, wherein the interior surfaces         mate to align the first and second throughholes.

The device of FIGS. 1 a-1 d possesses mating dovetail features on its interior surfaces. These features help maintain the device in its assembled form. The device of FIGS. 1 a-1 d also possesses aligned vertical throughholes through each component in its assembled form. These aligned holes help provide desirable bone growth through the device.

In use, the component halves of the device of the present invention are inserted into the disc space is a sequential fashion and are assembled in situ. Now referring to FIG. 1 e , the lower component 11 is first inserted into the disc space, with the tapered portion pointing posteriorly, so that it rests upon the floor of the disc space. The reduced height of the lower component allows it to be inserted without any need for distraction. Now referring to FIG. 1 f , the inside surface of the upper component is mated to the inside surface of the lower component and advanced into the disc space. Because the height of the combined components is greater than the disc space, and because the nose of the upper component is tapered, gradual insertion of the upper component into the disc space in this manner provides a gradual distraction of the disc space. Now referring to FIG. 1 g , the assembled component is located within the disc space.

In one embodiment, the interior surface of the top and/or bottom portion is generally parallel to their exterior surface. Now referring to FIG. 2 , there is provided an intervertebral fusion cage, comprising:

-   -   a) an upper component 21 having a first outside surface 23         adapted for gripping an upper vertebral endplate and a first         interior surface 25, a first sidewall 27 and a second opposed         sidewall (not shown),     -   b) a lower component 31 having a second outside surface 33         adapted for gripping a lower vertebral endplate and a second         interior surface 35, a third sidewall 37 and a second fourth         sidewall (not shown), wherein the interior surfaces mate,         wherein at least one of the components has a lateral throughhole         39 extending from a sidewall thereof to its opposed sidewall,         and wherein at least one of the outside surfaces is         substantially parallel to its corresponding interior surface.

An alternative embodiment would have sloped sides and/or non-parallel throughhole walls. These walls may be curved inwards (concave) or bowed outward (convex). Such an embodiment would increase the mechanical structural stability of the assembled device. Additionally, increasing the devices' mating surface areas would give additional room for the dovetail and locking features. Simultaneously, increased mating surface areas would decrease normal and shear load distributions at the mating surfaces, thereby decreasing likelihood of mechanical failures and further minimizing potential for the generation of particulate wear debris.

The device of FIG. 2 possesses a component that has parallel outside and interior surface. The device of FIG. 2 also possesses aligned lateral throughholes through at least one of its components. These holes help in desirable bone growth through the device.

Now referring to FIG. 3 , there is provided the upper 41 and lower 51 halves of the intervertebral fusion cage of the present invention, along with an assembled cage 42 attached to an insertion instrument 44. The intervertebral fusion cage comprises:

-   -   a) an upper component 41 having a first outside surface 43         adapted for gripping an upper vertebral endplate, a first         interior surface 45 having a recess 46, and a tapered distal end         47,     -   b) a lower component 51 having a second outside surface 53         adapted for gripping a lower vertebral endplate and a second         interior surface 55 having a projection 56 and a taper distal         end 58, wherein the interior surfaces mate so that the recess         and projection form a stop 57 and the tapered distal ends form a         bullet nose 60.

The upper component of the device of FIG. 3 possesses a bullet distal nose. This bullet nose helps the upper component distract the disc space as it is inserted into the disc space. The insertion instrument 44 includes a rail 48, a top pusher 50, and a bottom rod 52 having a projection 54 that mates with a recess 38 in the lower component of the cage.

In another embodiment, the interior surface 63 of the lower component 61 creates a ramp having an angle a with respect to its corresponding outer surface 65 (FIG. 4 ). The upper component 67 of the implant translates along this ramp, creating lordosis.

Because the two pieces of the cage are inserted sequentially into the disc space, the “insertion” height of the assembly and thus the height of the annular defect required during the insertion is approximately one half of the assembled device height.

Now referring to FIG. 5 a , there is provided an intervertebral fusion cage, comprising:

-   -   a) a first component 71 having a first outside surface 73         adapted for gripping a first vertebral endplate, a first         interior surface 75, and a recess 77 in the first interior         surface extending toward the first outside surface,     -   b) a second component 81 having a second outside surface 83         adapted for gripping a second vertebral endplate, a second         interior surface 85, and an extension 87 extending from the         second interior surface toward the first interior surface,         wherein the recess and extension of the interior surfaces mate         to provide nesting of the components.

Now referring to FIGS. 5 b and 5 c , there is provided a method of inserting the nested cage of FIG. 5 a : Place the baseplate 81 in the interbody disc space. Position and slide the overrider plate 71 onto and over the baseplate 81. Initially, the overrider nose 78 will slide across the base plate's interior surface 87 thereby creating a slight over-distraction of the disc space. As the overrider's posterior aspect 75 approaches the baseplate's posterior niche 85, the anterior overrider nose 78 will fall into the anterior niche 88 thereby providing a positive stop and locking mechanism to seat the overrider plate 71 onto the baseplate 81.

The preferred method for the order of insertion of the two-piece cage of the present invention is now disclosed. The first step can be placement of the first component of the device against the inferior vertebral body. This is often followed by insertion and eventual assembly of the second component onto and over the first component. The first component should contain a lordosed or angled component such that the surface over which the second component is inserted is substantially parallel to the superior vertebral endplate.

Alternatively, the method of inserting the first component with substantially parallel bone contacting and interior surfaces requires that the second component to contain a lordotic angle. As this two-piece assembled cage is typically inserted from a posterior approach, and the angle of the interbody cavity widens anteriorly, insertion of the second component with a lordotic angle requires over-distraction of the posterior aspect of the interbody space to accommodate the larger/taller anterior aspect of the second component. This over-distraction and the associated increased insertion force is not associated with the preferred method where the lordosed component is inserted first followed by the height-restoring component with substantially parallel sides.

Now referring to FIG. 6 , there is provided an intervertebral fusion cage, comprising:

-   -   a) a first component 101 having a first outside surface 103         adapted for gripping an upper vertebral endplate and a first         interior surface 105, a first sidewall 107 extending between the         first outside surface and the first interior surface and having         an outer surface (not shown) and a second opposed sidewall 109         extending between the first outside surface and the first         interior surface and having an outer surface (not shown),     -   b) a housing component 111 having a second outside surface 113         adapted for gripping a lower vertebral endplate and a second         interior surface 115, a third sidewall 117 extending from the         second interior surface and away from the second outside surface         and having an inner surface 118, and a fourth sidewall 119         extending from the second interior surface and away from the         second outside surface and having an inner surface 120, wherein         the interior surfaces mate, and wherein the outer surfaces of         the first component mates with their respective inner surfaces         of the housing component.

In FIG. 6 , one of the components has extending side walls that create a housing adapted to capture the other component. The advantage of this embodiment is that it possesses an enhanced dovetail creating enhanced stability.

Now referring to FIGS. 7 a-b , there is provided a device for inserting the components of the present invention into the disc space. FIG. 7 a discloses the disposition of the instrument during insertion of the inferior component into the disc space. FIG. 7 b discloses the disposition of the device when the upper component is advanced into the disc space to the point where it rides on top of the lower component and forms the assembly.

The endplates may have teeth to prevent migration and perforations to allow bone growth.

Radiographic markers can be incorporated to allow intra- or post-operative visualization.

Additionally, the outside surfaces of the superior and inferior portions can be designed with varying geometries to allow for their customization to the patient's anatomy, thereby minimizing the risk of subsidence. For instance, the outside surface of the superior half may have a convex dome while the outside surfaces of the inferior half may be flat, convex, concave or serpentine (concave posterior and convex anterior).

In an alternative embodiment, an arcuate sliding mating pathway is contemplated. FIGS. 8 a-8 c disclose arcuate cages of the present invention forming a lordotic angle 201 (FIG. 8 a ), no angle 203 (FIG. 8 b ) and a kyphotic angle 205 (FIG. 8 c ). FIG. 8 d discloses a lordotic arcuate cage 201 inserted into a disc space.

The benefit to assembling the two cage halves using an arcuate assembly pathway is the potential to provide in situ determination of lordotic angle. Also, the arcuate pathway would embody a mechanism allowing a continuously variable lordotic angle (as opposed to discrete lordotic angles represented by assembly of different superior or inferior cage components). The arcuate mating mechanism requires that one half of the cage contains a convex mating surface while the other half contains a concave mating surface with an arcuate geometry that exactly mimics the inverse of the opposite curve. The assembled halves would represent a fixed radial distance about some center of rotation (the geometric centroid of the arcuate pathway). This fixed radial distance represents the cage height. As the superior cage half slides along the arcuate mating surface of the inferior cage half, the lordotic angle of the assembly will vary continuously. Detents, stops, or teeth can be inserted into the arcuate pathway to create discrete increments of lordotic angles along the continuous arcuate pathway, if this is a preferred further embodiment.

The arcuate pathway enables similar seating features compared to the planar device mating pathway—dovetails, keyways, detents, snap-fits, set screws, etc.

The two halves of the device may be secured together by various means. For instance, a dovetail feature may be incorporated into the interior surfaces of the top and bottom portions for ease of insertion, as shown in FIGS. 1 a-f , 2 and 3. The two components may also be stacked and nested together without a dovetail, as shown in FIGS. 5 a-c , or the superior/inferior half may have side walls creating a housing that captures the other portion, as shown in FIG. 6 . The two portions of the device may be locked together in a variety of locking means including but not limited to Morse taper locks, positive stop(s), ultrasonic welding, snap mechanism(s), a set screw, a clip, a collet, cams, etc. Additional design features can be included to aid in seating the two halves: mechanical keys, a threaded nut can screw onto threaded features on the posterior aspect of each half, and a mechanical channel can be incorporated into the design for the use of curing compounds like adhesives and grouts.

Both components of the device may also incorporate a variety of holding means to assist during the insertion of the device. These holding means may be located on the interior or exterior surfaces as well as along the sidewalls. For example, the top and/or bottom portion may have threaded holes, divots, or slots to provide for secure holding and cage support during insertion, placement and assembly.

After placing the inferior portion, the superior portion can be inserted by several means to expand the overall device height and provide appropriate lordosis or kyphosis.

The superior and inferior portions are generally hollow to provide for filling with various osteogenic fillers and can be porous to allow for graft filling, bony ingrowth and spinal fusion. Lateral openings can also be incorporated to increase vascularization of the osteogenic fillers as well as to provide post-operative visualization of the bony fusion process. Filling can be done preoperatively or intraoperatively, as a through hole into the wedge can facilitate filling of the entire construct in situ.

Unlike traditional single-piece cages, the two-piece assembled cage requires sliding articulation of two half-cages packed with bone. Bone packed within a cage is typically held in place using friction forces. The sliding assembly mechanisms described could potentially dislodge packed bone graft during cage insertion and/or assembly. To mitigate the dislodgement of bone chips or the potential for sliding-interference of the bone chips, bonding a resorbable lamina of material between the two halves is proposed. Such a lamina could be placed on the interior surface 45 of the upper half 43 (see FIG. 3 ). Such a resorbable member could be applied to all cage openings but is of particular utility to prevent dislodgement or interference of the bone graft during sliding assembly of the two halves.

The present invention also offers novel trialing methods. The inferior or superior portion of the implant device can be inserted alone to confirm disc space clearance and device placement, and a trial of the superior component can be placed upon the inserted component to confirm disc height, lordosis, and placement.

Because these cages reduce the profile required for their insertion, they allow for implantation through a cannula that may be smaller than the conventional cannula.

The endplates can be made of any structural biocompatible material including resorbable (PLA, PLGA, etc.), non-resorbable polymers (CFRP, PEEK, UHMWPE, PDS), metallics (SS, Ti—6Al—4V, CoCr, etc.), as well as materials that are designed to encourage bony regeneration (allograft, bone substitute-loaded polymers, growth factor-loaded polymers, ceramics, etc.). The materials for the upper and lower components are biocompatible and generally similar to those disclosed in the prior art. Examples of such materials are metal, PEEK and ceramic.

In preferred embodiments, each of the upper and lower components is manufactured from a material that possesses the desirable strength and stiffness characteristics for use as a fusion cage component.

These components of the present invention may be made from any non-resorbable material appropriate for human surgical implantation, including but not limited to, surgically appropriate metals, and non-metallic materials, such as carbon fiber composites, polymers and ceramics.

In some embodiments, the cage material is selected from the group consisting of PEEK, ceramic and metallic. The cage material is preferably selected from the group consisting of metal and composite (such as PEEK/carbon fiber).

If a metal is chosen as the material of construction for a component, then the metal is preferably selected from the group consisting of titanium, titanium alloys (such as Ti—6Al—4V), chrome alloys (such as CrCo or Cr—Co—Mo) and stainless steel.

If a polymer is chosen as a material of construction for a component, then the polymer is preferably selected from the group consisting of polyesters, (particularly aromatic esters such as polyalkylene terephthalates, polyamides; polyalkenes; poly(vinyl fluoride); PTFE; polyarylethyl ketone PAEK; polyphenylene and mixtures thereof.

If a ceramic is chosen as the material of construction for a component, then the ceramic is preferably selected from the group consisting of alumina, zirconia and mixtures thereof. It is preferred to select an alumina-zirconia ceramic, such as BIOLOX Delta™, available from CeramTec of Plochingen, Germany. Depending on the material chosen, a smooth surface coating may be provided thereon to improve performance and reduce particulate wear debris.

In some embodiments, the cage member comprises PEEK. In others, it is a ceramic.

In some embodiments, the first component consists essentially of a metallic material, preferably a titanium alloy or a chrome-cobalt alloy. In some embodiments, the second component consists essentially of the same metallic material as the first plate.

In some embodiments, the components are made of a stainless steel alloy, preferably BioDur® CCM Plus® Alloy available from Carpenter Specialty Alloys, Carpenter Technology Corporation of Wyomissing, Pa. In some embodiments, the outer surfaces of the components are coated with a sintered beadcoating, preferably Porocoat™, available from DePuy Orthopaedics of Warsaw, Ind.

In some embodiments, the components are made from a composite comprising carbon fiber. Composites comprising carbon fiber are advantageous in that they typically have a strength and stiffness that is superior to neat polymer materials such as a polyarylethyl ketone PAEK. In some embodiments, each component is made from a polymer composite such as a PEKK-carbon fiber composite.

Preferably, the composite comprising carbon fiber further comprises a polymer. Preferably, the polymer is a polyarylethyl ketone (PAEK). More preferably, the PAEK is selected from the group consisting of polyetherether ketone (PEEK), polyether ketone ketone (PEKK) and polyether ketone (PEK). In preferred embodiments, the PAEK is PEEK.

In some embodiments, the carbon fiber comprises between 1 vol % and 60 vol % (more preferably, between 10 vol % and 50 vol %) of the composite. In some embodiments, the polymer and carbon fibers are homogeneously mixed. In others, the material is a laminate. In some embodiments, the carbon fiber is present in a chopped state. Preferably, the chopped carbon fibers have a median length of between 1 mm and 12 mm, more preferably between 4.5 mm and 7.5 mm. In some embodiments, the carbon fiber is present as continuous strands.

In especially preferred embodiments, the composite comprises:

-   -   a) 40-99% (more preferably, 60-80 vol %) polyarylethyl ketone         (PAEK), and     -   b) 1-60% (more preferably, 20-40 vol %) carbon fiber, wherein         the polyarylethyl ketone (PAEK) is selected from the group         consisting of polyetherether ketone (PEEK), polyether ketone         ketone (PEKK) and polyether ketone (PEK).

In some embodiments, the composite consists essentially of PAEK and carbon fiber. More preferably, the composite comprises 60-80 wt % PAEK and 20-40 wt % carbon fiber. Still more preferably the composite comprises 65-75 wt % PAEK and 25-35 wt % carbon fiber.

Although the present invention has been described with reference to its preferred embodiments, those skillful in the art will recognize changes that may be made in form and structure which do not depart from the spirit of the invention.

Alternatively, combinations of cage materials could be beneficial (i.e.,—a ceramic bottom half with a PEEK top half). 

What is claimed:
 1. A method of operating an intervertebral fusion system to implant an intervertebral fusion cage, the method comprising the steps of: a) inserting a first component into an intervertebral space such that an outside surface of the first component abuts a first vertebral endplate, wherein the first component defines an interior surface that is opposite the outside surface along a first direction and defines a recess; and b) translating an extension of a second component with respect to the first component in the recess along a second direction that is perpendicular to the first direction, which causes a smooth engagement surface of the extension to slidably ride along a smooth ramped surface of the first component so as to selectively increase and decrease a distance between the outside surface of the first component and the second component along the first direction, wherein the second component first has a pair of opposed first and second surfaces that are opposite each other along the first direction, an end, and a receiving hole that extends into the end along the second direction, wherein the intervertebral fusion system further comprises 1) a third component that defines a receiving hole that is aligned with the receiving hole of the second component along the second direction, and 2) a rod that is oriented along the second direction and is received by both the receiving hole of the second component and the receiving hole of the third component.
 2. The method of claim 1, wherein the recess is defined in the interior surface and extends toward the outside surface, one of the pair of opposed first and second surfaces defines the extension, and the extension extends away from the other of the opposed first and second surfaces.
 3. The method of claim 2, wherein the inserting step causes teeth at the first outer surface of the first component to grip the first vertebral endplate.
 4. The method of claim 2, wherein a first end of the rod is threadably received in the receiving hole of the second component.
 5. The method of claim 2, further comprising the step of moving the rod along the second direction in the receiving hole of the third component.
 6. The method of claim 2, wherein movement of the third component along the second direction with respect to the second component causes the extension to slidably mate with the first component in the recess.
 7. The method of claim 2, wherein the translating step causes the extension to bear against the interior surface, thereby urging the first component away from the second component along the first direction.
 8. The method of claim 1, wherein the smooth ramped surface of the first component is sloped in a plane that is oriented along the first and second directions.
 9. The method of claim 8, wherein the smooth engagement surface is sloped in the plane.
 10. A method of operating an intervertebral fusion system to implant an intervertebral fusion cage, the method comprising the steps of: inserting a first component into an intervertebral space, such that an outside surface of the first component abuts a vertebral end plate, wherein the first component defines an interior surface opposite the first outside surface along a first direction, and the interior surface defines first and second surfaces that are angled with respect to each other and are spaced from each other along a second direction that is perpendicular to the first direction; and slidably mating third and fourth surfaces of a second component with respective ones of the first and second surfaces along the second direction so as to cause the first component to move linearly away from the second component along the first direction, wherein the third and fourth opposed surfaces are defined by one of opposed surfaces of the second component that are opposite each other along the first direction, wherein the third and fourth surfaces that are angled with respect to each other, wherein the intervertebral fusion system further comprises a third component separate from each of the first and second components, and a rod that is received in both the second component and the third component, and wherein the rod is oriented along the second direction, one of the first and second surfaces is angled with respect to the other of the first and second surfaces along the second direction as it extends along the first direction, and one of the third and fourth surfaces is angled with respect to the other of the third and fourth surfaces along the second direction as it extends along the first direction.
 11. The method of claim 10, further comprising the step of threadedly engaging a first end of the rod in a receiving hole defined at an end of the second component.
 12. The method of claim 11, further comprising the step of slidingly receiving a second end of the rod in a receiving hole of the third component.
 13. The method of claim 12, wherein the receiving hole of the third component extends entirely through the third component.
 14. The method of claim 10, wherein the intervertebral space is defined by the first vertebral endplate and a second vertebral endplate, and the slidably mating step causes the second component to urge the first component to move away from the second component as one of the first and second interior rides along a complementary other of the third and fourth surfaces.
 15. The method of claim 10, wherein the first and second surfaces converge in a direction from the interior surface toward the outside surface, and the third and fourth surfaces also converge in the direction.
 16. The method of claim 10, wherein the rod is oriented in a second direction that is perpendicular to the first direction, such that a portion of the interior surface that extends from the first surface to the second surface is flat as it extends along the second direction.
 17. The method of claim 10, wherein the first and second surfaces are disposed outboard of the third and fourth surfaces with respect to the second direction.
 18. The method of claim 10, further comprising the step of threading the rod in the second component.
 19. The method of claim 10, wherein each of the first, second, third, and fourth surfaces have a constant slope in a plane that is oriented along the first and second directions. 